严重耐多药结核病的临床实验室监测  

Clinical laboratory-base surveillance of extensively drug-resistant tuberculosis

作　　者：邓云峰[1] 王俊玲[1] 王燕[1] 孟宪春[1] 于春宝[1] 王海英[1] 

机构地区：[1]山东省胸科医院汉光国际感染性疾病研究中心,济南250013

出　　处：《中华检验医学杂志》2008年第8期876-879,共4页Chinese Journal of Laboratory Medicine

基　　金：基金项目：山东省科学技术发展计划（2007GG20002029）

摘　　要：目的监测结核分枝杆菌对一线和二线抗结核药物的耐药性水平，掌握严重耐多药结核病的流行情况。方法2004年10月至2007年4月期间山东省胸科医院收集的1021株临床菌株，采用绝对浓度法在鸡蛋培养基上检测1021株菌株对4种一线和5种二线抗结核药物的药物敏感性。结果结核分枝杆菌复合群989株（96．9％），非结核分枝杆菌32株（3．1％）。989株结核分枝杆菌对一线抗结核药物的总体耐药率为32．3％（95％可信区间为28．7％～35．8％），其中耐多药结核菌株107株（10．8％），有20株菌株符合严重耐多药结核的定义标准。严重耐多药结核菌株占所有耐多药结核菌株的18．7％，全部来自复治肺结核患者。结论结核分枝杆菌对二线抗结核药物耐药性水平较高，严重耐多药结核在复治结核患者中的流行情况严重。研究显示持续开展抗结核药物耐药性的临床实验室监测十分必要。Objective To evaluate the first-line and second-line anti-tuberculosis drugs resistance of clinical Mycobacterium tuberculosis （M. TB） isolates and the prevalence of Extensively Drug-Resistant Tuberculosis （XDR-TB） in hospital-base TB patients in Shandong province, China. Methods Absolute concentration method based on egg medium were examined for drug-resistance of M. TB strains to 4 first-line anti-tuberculosis drugs （INH, RFP, SM, and EMB） and 5 second-line drugs （FQ,CPM,AMK,and PAS）. Results 1 021 isolates were obtained from clinical TB patients at Shandong Provincial Chest Hospital during November 2004 to April 2007. Of those, 32 strains （3.1%） were identified to Mycobacterium other than tuberculosis. Among 989 M. TB complexe isolates, the general resistance rate to first-line drugs were 32. 3% （95% C1：28.7% -35.8% ）, 107 isolates （10. 8%） were found to be MDR-TB. According to the revised Global XDR-TB Task Force definition, a total of 20（18.7%） MDR-TB patients met criteria for XDR-TB. All XDB-TB patients were previously treated pulmonary tuberculosis cases. Conclusions The prevalence of resistant to second-line anti-tuberculosis drugs in Mycobacterium tuberculosis was very serious, and high prevalence of XDR-TB in hospital-base patients was found in high-level. The study showed that it is important to successively survey the anti-tuberculosis drug resistance in clinical laboratory.

关 键 词：结核 抗多种药物性 分枝杆菌 结核 微生物敏感性试验 药物监测 

分 类 号：R686[医药卫生—骨科学]